While you are waiting for your heart transplant and while you are recovering after surgery, you will undoubtedly be aware of the major expenditures that will keep you alive. Regardless of the quality of your health insurance and prescription coverage, you are going to bear some of that cost.

Over my 12-year battle with heart disease, I have become observant about how the medical profession treats patients and how patients feel about their treatment. Over the last 12 years, I have seen The Good, The Bad and The Ugly.

My health insurance company, a local not-for-profit, called Capital District Physicians Health Plan (CDPHP), is one of The Good experiences. CDPHP provided me terrific personal advice and counsel through their health coaching program. They have been a dependable provider; no easy feat in this day and age.

But, there is no escaping the high cost of heart transplantation. My recovery has been trying and expensive. Were it not for the fluid, consistency and personal interest afforded me by my health insurance carrier, I would not have received my new organ. Nor would I have met three of my eight grandchildren.

In the past 30 days, I have had 18 doctor’s appointments. I reached a numbing point where I cannot review the costs of the paid claims any longer. I feel badly for my carrier. The medical system is filled with waste. What’s more, the doctors, nurses, caregivers and administrators know it. Talk about tax reform, this system needs reform, and it’s not all about litigatioin limits. It is very much about waste, duplication of services and a lackadaisical approach to the business side of the industry. This is the Bad.

The health insurance industry would do well to consider Henry Chesbrough’s “open innovation” policies that businesses around the world and all government agencies now use. One of President Obama’s first initiatives was to insist upon cooperation and transparency between government agencies. The biggest benefit of open innovation and collaboration is the sharing of possible terrorist activities between numerous agencies. This directive received acclaim from the Secretary of Defense and the Directors of the CIA and the FBI, three agencies that previously operated in a closed innovation environment where information was territorial.

Open innovation is the sharing of ideas and research for the common good. The program was developed by Harvard professor Henry Chesbrough who has authored three books on the topic. Open innovation has crossed the globe and is now a core principle in every business school in the US. Most recently, Chesbrough has been advising the European Union in attempting to untangle the financial and political chaos that has permeated the region.

21st century corporations seek partners in other industrial sectors in order to reduce the cost of research and development. Business has found this is the quickest, most efficient way to bring products to market.

In an earlier article, I referenced one perfect open innovation scenario. A pediatric cardiologist at the Children’s Hospital of Boston found that his young infant patients could not tolerate the invasive surgery necessary for heart valve exploration and replacement. The surgeon developed a minimally invasive probe but had no idea how to navigate it through the patient’s arterial structure. The doctor approached a digital gaming company who designed a joystick that enabled the use of the probe with minimal surgery. Everybody wins! That is the nature of open innovation. This is the best!

The difficult part of open innovation and medical costs is making the commitment to change an industry culture with a tradition of waste. Much of the waste I have seen takes place on the diagnostic side. However, if I understood what was happening behind the scenes, my guess is that the waste would be more staggering.

Recently I felt a little like a football being referred to three office for the same problem. At each office the physicians insisted on new x-rays. Of course the results and diagnoses were exactly the same because the images were excactly the same. No matter how you cut the cake, that is a bad business model and a practice that insurers should stop. This is the bad!

An open innovation model applied to the health care industry could save everyone a great deal of money. In my 12-year battle with heart disease, there has been so much waste. It seems that unless insurance companies come together and take the initiative to control costs, the price of health insurance will continue to rise. It is not the quality of care or service that drives health insurance rates. It is the culture and the waste. The first problem to solve is to eliminate the waste in a system that all participants know is broken. This is the right time for courageous industry wide reform. While the country faces far-reaching austerity cuts, the health industry should be a leader in eliminating waste.

If health insurers developed an open innovation protocol, huge savings would have to follow. Perhaps, we could even see health insurance costs reverse the upward trend. Under the current system, there is no incentive for physicians to cut costs and health insurers accept waste because it can be charged to subscribers in next year’s premiums. What the industry needs is a cooperative effort to address this important challenge.

The High Cost of Heart Transplantation

1 Comment on "The High Cost of Heart Transplantation"

If the gov’t took this seriously, top to bottom, we’d eliminate 50% of our bureaucratic structure and waste and senseless jobs filled by hangers on ’till retirement. Send your ideas to your representatives and see what you get back.

Don’t expect to live long enough to see an impact. I’ll carry on for you.